The first time I came into contact with post-refractive cataract patients was ten years ago, when I was still a master’s student in Tongren Hospital. “So I started a special relationship with the subject of “post-refractive cataract surgery”.
The owner of that medical record is a forty-year-old female white collar worker who underwent “bilateral excimer laser in situ keratomileusis” five years ago in an outside hospital. Although she was only in her forties, her lens had already developed a significant clouding, commonly known as a cataract. People with high myopia are prone to complications of “nuclear cataract”, and the onset of the disease is earlier than that of “senile cataract”, and this woman is a typical case. At that time, the technology of ultrasonic cataract surgery was very mature, and the manufacturing process of IOL (Intraocular lens) was also very advanced, so the surgery on her right eye was flawless. The residual refraction was +9.0D (i.e., 900 degrees of hyperopia), which brought great distress to the patient’s life, and the surgeon was at her wits’ end, so she was advised to come to Tong Ren Hospital for a specialist consultation.
It was only a decade or so after the emergence of corneal refractive surgery in China, and the long-term research on corneal refractive surgery was still in the exploratory stage worldwide, and in China at that time, even experienced and skilled cataract surgeons had little research on such patients. It is well known that the principle of refractive surgery is to reduce the corneal refractive rate by laser cutting the corneal stroma, which is like a convex lens, if the convex side of it is smoothed out, its magnifying effect will be reduced. As a result, the curvature of the abnormal morphology could not be accurately measured, and it would not be at all surprising if the IOL measurement was still performed according to the conventional method, as in the case above.
After reviewing a large amount of literature, I finally figured out what was going on, and based on the methods mentioned in the literature, we re-performed the biometry for the patient. There are several correction methods reported in the foreign literature, but because of the small number of cases, they are not mature. IOL measurement formula to obtain the required IOL degree. After solving the most important problem, we scheduled the patient for reoperation. Since the patient already had an IOL implanted and the IOL may have been tightly adhered to the lens capsule, we developed two sets of surgical plans for the patient: first, if the original IOL could be removed successfully, then IOL replacement was performed. Second, if the IOL was so tightly adherent that it could not be removed without damaging the capsular bag, the “Pigback” method was used to fold away the original IOL and implant a lower IOL in the ciliary sulcus, stacking it in front of the original IOL to complete the refractive effect.
During the preoperative conversation, I explained to the patient in detail the process of my research, the results and the two surgical plans, and explained the possible problems during and after the operation. “, but I knew in my heart that the result of this surgery would never let them down.
On the day of the surgery, Director Zhu Siquan personally took the lead, making a lateral incision, a main incision, injecting viscoelastic, and trying to remove the IOL. The entire procedure took only 4 minutes.
On the first day after surgery, when the patient removed the gauze covering her eye, a long-awaited smile appeared on her face. Her postoperative naked eye vision recovered to 0.8. After a week of postoperative recovery, she underwent cataract surgery on her second eye, and her postoperative vision was also good.
It can be seen that the main difference between post-refractive cataract surgery and ordinary cataract surgery is preoperative rather than intraoperative, and the difficulty is mainly focused on the measurement of corneal curvature before surgery. morphology can no longer be accurately measured by conventional methods, and must be effectively corrected by various types of modified formulas, such as the clinical history method, shammer formula, Higis L formula, etc. The results are then combined with values such as eye axis length to calculate the IOL degree required intraoperatively, while the surgical procedures and postoperative care for cataract are not significantly different from those for ordinary cataract surgery. Therefore, at the end of this article, we would like to make a few suggestions for patients who have undergone or are planning to undergo keratomileusis surgery: 1. Keep the medical records before and after keratomileusis surgery.
2.Before receiving cataract surgery in the future, make sure to clearly inform the history of keratoconus surgery and actively cooperate with the doctor for preoperative examination.
3.Methods for direct measurement of post-refractive corneal curvature already exist, but the mainstream method is still to apply the correction formula. A combination of methods can be used to verify the accuracy of the values.
Bright eyes are the desired state of everyone, but how to use the eyes scientifically and reasonably, or should listen to the advice of professionals, to provide accurate and professional ophthalmic guidance for the public is the biggest dream of each member of the Sizhuan Eye Clinic is also our goal, heavy work and a long way to go, and walk and work hard, our victory is ahead.